The Ado About Doulas

What is a doula? A doula is not, as my brother thought, a part of the female anatomy. She is a birth companion, someone who has a deep understanding of the birth process. She knows the stages of labor, what helps to keep things moving and when is a good time for the mother to take a break and conserve her energy. A doula is there to make sure the partner feels needed and useful, to remind the couple to eat and drink, and to help couples remember their labor desires in the face of pressure from the medical team. A doula does not have her own agenda; she is there to help the couple have whatever kind of birth they desire and she knows the risks and benefits of various procedures. (Also to note: a doula can be a man, but as they’ve traditionally been women, I will continue to use the feminine pronoun.)

Until somewhat recently, I wasn’t very familiar with the doula concept. I thought she was someone you hired if you were without a partner. But after I had Menininho, I wished I’d had a 2nd person with us, someone to stay with me so Mark could go with our baby to ensure our wishes were carried out.

As I became more active on Twitter, I met several doulas: Kayce, Gina, Cassie, Desiree, and others. They gave me a much more accurate picture of the doula’s role and I realized that if I got pregnant again I would want one. Having another family member or friend to help would be ok, but a doula brings a level of expertise that I knew I’d want to help me be successful with my goal of a VBAC.

There is data to show that doulas are effective:Women cared for during labor by a birth doula, compared to those receiving usual care were
26% less likely to give birth by cesarean section
41% less likely to give birth with a vacuum extractor or forceps
28% less likely to use any analgesia or anesthesia
33% less likely to be dissatisfied or negatively rate their birth experience
(Hodnett E, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2003. Issue 3, via DONA, taken from Birth Faith)

I was lucky that Mark was on board with this desire. After I became pregnant with Smudge, I started my doula research in earnest. I wanted someone who was comfortable with the idea of a high-intervention VBAC, since I knew I’d need an epidural and frequent monitoring, and who would be ok with being a support through a c-section should things end up that. I also wanted someone who had some experience with VBACs and wouldn’t just give up on me as being someone who would end up getting cut again.

The first time I spoke with P., I knew she was the woman I wanted as my doula. I told her a bit about my situation and she immediately had several ideas for keeping labor moving even while being confined to a bed with an epidural. She also counseled me to plan out what an idea c-section might look like for me, because otherwise I might allow the result of c-section equal failure, and that should not be the case. I came home and told Mark that we were set. I did attend a local meet-the-doula night later that week to be sure, liked almost everyone I spoke with (one doula immediately began to question the research about Marfan patients using epidurals and insisted I didn’t need one, so that was the end of that interview), but kept coming back to P., who was also there.

Long story short, she contacted me shortly thereafter about setting up a formal interview with Mark present. That was a great opportunity for him to learn more about how the doula aids the husband during labor. We signed the contract later that evening.

I feel like a huge weight has been lifted from my shoulders! Although I’m very excited to have Smudge, I’ve also been really apprehensive about the labor given my previous experience and knowing at least some of my team would prefer me to have a c-section. (For example, while the anesthesiologist promised I’ll be allowed to go till 5 cm before I get the epidural, I lost track of how many times she talked about “the c-section” and how I am at “high risk” for a c-section and all the different reasons I might need a c-section…not because of having Marfan, but just because I’m doing a VBAC, and research doesn’t support her assertions.) I’m much more at ease now knowing I have someone on our team who is rooting for me to be successful in what I believe is best for me and my baby.

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4 Comments

Maya, I’m so impressed with all you are doing to have the childbirth experience that you want. Too many women don’t do this. It’s your body, your baby, your childbirth! Although I did not use a doula, I can point you to a website where you can find a lot of information on doulas (maybe some questions that even you didn’t think of!): http://www.childbirthconnection.com. I know how informed you are about Marfan syndrome so it’s not a surprise that you are taking charge of this too!

That’s awesome! I’m glad you found someone. We wanted a doula for Eryn’s birth, but I was unable to find one who wanted to hang around (!?!) I don’t quite know what happened, but we had interviews with three doulas, and while I was comfortable with any of them, each had a sudden conference to attend or family crisis that would interfere with me being a client.

It didn’t matter in the end — and while I didn’t quite get the birth I envisioned, I got a really great birth experience.

A timely post, as I was just talking to Scott about a big local throw-down about doulas. The OBGYN practice I go to is prominent in Columbus and recently decided to ban doulas at their births: http://birthingbeautifulideas.com/?p=1922 .

It’s an interesting topic for me because my sister-in-law’s sister is a doula and helped her a ton with her birth, but I can see how a doctor would be quickly frustrated by a “second opinion” in the delivery room with far less training and experience. From what I understand, with ~30 hours of training and having “helped” at 3 births, one can be considered a fully-certified doula.

There’s no doubt that having support during delivery (and afterward) is incredibly helpful, but trusting someone other than a doctor to know “the risks and benefits of various procedures” (especially in such a complex case as yours) would make me nervous. I think the most significant thing is how you view the doula’s role. For me, having an experienced woman in the room who knew me (unlike the nurses) would be a boon, but I could never see them as being “part of the team” along with the doctors and nurses. But then again, I am married to a doctor!

I hope things go smoothly for this delivery and that you come away healthy, with a healthy baby, and with a good experience. Oh, and I also hope the crazy pain doesn’t come back. Scary! (Though I’m sure the MRI helped put your mind at ease some.)

Wow! I am surprised they banned doulas. The doula’s job is NOT to communicate with the medical team. They should be there for the couple, but not communicating with the medical staff; that’s the couple’s job. A doula doesn’t prescribe interventions. Her role is to help remind you of what you want and what may or may not happen if you follow that path…more of an advocate for informed consent, if you will. Of course, not all doulas follow that and that’s too bad. As for the qualifications to become certified, those are part of DONA’s criteria (in addition to a long list of other requirements), but each certifying organization has their own rules (CAPA and Birthing from Within are two others).

I have to be honest…I don’t trust the obstetrics profession overall to give proper informed consent. That’s not meant as a slam against all doctors, please don’t think that! WHO recommends a c-section rate of 10-12%. In the US, it’s much higher (32.3% in 2008). CA has a huge (compared to the average) maternal mortality rate, and a recent study from the Palo Alto Medical Foundation found this may be due, at least partially, to the rate of unnecessary c-sections performed here. We unfortunately live in a litigious society and OBs have had to bear the brunt of that: unfairly. It seems to me that a fear of lawsuits makes them more ready to perform surgery, as they are surgeons and can better control what is in their hands in front of them than they can with labor. But, that’s not what’s best for most women.

Hospitals are banning VBACs but not telling women about all the risks associated with a second or third c-section. There is only a 0.4-2% risk of uterine rupture for most VBACs; hardly cause to ban the procedure! ACOG *finally* wrote something in support of VBACs but I don’t see it doing much. There are other practices that have been shown to help with labor and bonding that are disappearing from the more medical philosophy of birth in the US. These include allowing labor to happen naturally (instead of inducing at 38 or 39 weeks), laboring in diff. positions (laying on your back can be the least productive/most painful way), delayed cord clamping, and skin to skin contact immediately following birth. Here is another great article, with citations, about labor myths.

I guess all that to say that I think we can’t just depend on doctors or nurses or doulas to tell us what to do. We need to do our own research. If I hadn’t, my OB team would have me scheduled for a c-section at 38 or 39 weeks, even though my cardiologist agrees a VBAC is safer. My doula will help show me some tactics I can use to keep my blood pressure down so I can hold off a bit on the epidural and being confined to the bed, something my OB wouldn’t do b/c he’d rather I do the epidural, since it’s “easier to monitor and control.” And as I talked about my epidural placement plan with anesthesiology, her entire conversation was about what would be easier for “my” c-section and NOT what would be best for my aorta. I kept having to redirect her.

So while I certainly won’t be trusting my doula to tell me what to do, and she wouldn’t do that even if I asked her to, I do want her as a part of my team because she has insight and training into aspects of birth that my medical team just doesn’t have. She’ll help remind me that it’s ok to take a minute to consider any decision I make, so that at the end of the day I can feel confident that I wasn’t rushed into a decision & that I made the right one, whether that’s getting an epidural at 5 cm instead of 3 cm, or deciding to go with a c-section after all.